Yttrium‐90 radiation segmentectomy for hepatic metastases: A multi‐institutional study of safety and efficacy

• Published in: Journal of surgical oncology Vol. 123; no. 1; pp. 172 - 178
• Main Authors: Padia, Siddharth A., Johnson, Guy E., Agopian, Vatche G., DiNorcia, Joseph, Srinivasa, Ravi N., Sayre, James, Shin, David S.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-01-2021
• Subjects: Ablation; Adult; Aged; Aged, 80 and over; Chemotherapy; Embolization, Therapeutic - mortality; Female; Follow-Up Studies; hepatic metastases; Humans; liver metastases; Liver Neoplasms - radiotherapy; Liver Neoplasms - secondary; Male; Metastasis; Middle Aged; Neoplasms - pathology; Neoplasms - radiotherapy; Prognosis; radioembolization; Retrospective Studies; Survival Rate; Tumors; Yttrium Radioisotopes - therapeutic use; radioembolization; hepatic metastases; liver metastases
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.26223

Background and Objectives
This study assessed the outcomes of Yttrium‐90 (90Y) radiation segmentectomy for hepatic metastases unamenable to resection or ablation.
Materials and Methods
Over 6 years, 36 patients with 53 tumors underwent segmental radioembolization. Patients were not candidates for surgical resection or thermal ablation. Malignancies included metastases from colorectal cancer (31%), neuroendocrine tumors (28%), sarcoma (19%), and others (22%). Eighty‐one percent of patients had undergone prior treatment with systemic chemotherapy. Ongoing systemic chemotherapy was continued. Toxicity, tumor response, tumor progression, and survival were assessed.
Results
The median tumor size was 3.6 cm (range 1.2–6.1 cm). Adverse event rates were low, with no hepatic‐related Common Terminology Criteria for Adverse Events Grade 3 or 4 toxicity. Target tumor Response Evaluation Criteria in Solid Tumors disease control rate was 92% (28% partial response, 64% stable disease). For patients with enhancing tumors (n = 14), modified Response Evaluation Criteria in Solid Tumors target tumor objective response rate was 100%. During a median follow‐up of 12 months, target tumor progression occurred in 28% of treated tumors. Overall survival was 96% and 83% at 6 and 12 months, respectively.
Conclusions
90Y radiation segmentectomy for hepatic metastases demonstrates high rates of tumor control and minimal toxicity. Radiation segmentectomy should be considered for patients with metastatic hepatic malignancy who are not candidates for surgical resection.